Journal of special operations medicine : a peer reviewed journal for SOF medical professionals最新文献

This article highlights key topic areas related to dietary supplements (DSs) and performance-enhancing substances. It also discusses evidence-based resources the medical community can use when discussing high-quality DSs with Servicemembers interested in taking DSs. We briefly overview how DSs are regulated in the United States, discuss problematic categories and issues related to quality, expand upon what are often considered performance-enhancing substances yet sometimes sold as DSs, and then offer solutions to counter the consequences of the dark side of the DS industry. Solutions include third-party certification and intentional education and resources, as military health care providers and medics need to know where to go for evidence-based information, per the Department of Defense Instruction 6130.06 - Use of Dietary Supplements in the DoD (DoDI 6130.06), which set policy and guidelines for Servicemembers in 2022. Finally, Operation Supplement Safety (OPSS) resources and tools are discussed.

Introduction: A systematic radiological examination is needed for military airborne troops in order to detect subclinical medical contraindications for airborne training. Many potential recruits are excluded because of scoliosis, kyphosis, or spondylolisthesis. This study aimed to determine whether complementary radiological assessment excludes too many recruits and whether medical standards might be lowered without increasing medical risk to appointees.

Methods: This retrospective, epidemiological, cross-sectional single-center study spanned 5 years at the French paratroopers' initial training center. We analyzed all medical files and full-spine X-ray results of all enlisted troops during this period. Secondary evaluation by an orthopedic surgeon enabled 23 enlisted personnel, deemed medically unacceptable because of X-ray findings, to be given waivers for airborne training. A follow-up review of their 23 files was conducted to determine whether static-line parachute jumps were hazardous to those who were initially declared medically unacceptable.

Results: Of the 3,993 full-spine X-rays, 67.5% (2,695) were described as having normal alignment and structure; 21.8% (871) had lateral spinal deviation; and 10.7% (427) had scoliosis. Sixty-six recruits (1.6%) were deemed unfit because of findings that did not meet the standard on the fullspine X-ray: 53 enlisted personnel had scoliosis greater than 15°, and 13 had spondylolisthesis (grade II or III). Of the 23 patients granted waivers, 82.3% with scoliosis (14) and all patients with kyphosis had not declared any back pain after 5 years.

Conclusion: The findings, supported by a literature review of foreign military data, suggest that spondylolisthesis above grade I and low back pain are more significant than scoliosis and kyphosis for establishing airborne standards.

Herein, we present a simplified approach to prehospital mass casualty event (MASCAL) management called "Move, Treat, and Transport." Prior publications demonstrate a disconnect between MASCAL response training and actions taken during real-world incidents. Overly complex algorithms, infrequent training on their use, and chaotic events all contribute to the low utilization of formal triage systems in the real world. A review of published studies on prehospital MASCAL management and a recent series of military prehospital MASCAL responses highlight the need for an intuitive MASCAL management system that accounts for expected resource limitations and tactical constraints. "Move, Treat, and Transport" is a simple and pragmatic approach that emphasizes speed and efficiency of response; considers time, tactics, and scale of the event; and focuses on interventions and evacuation to definitive care if needed.

Biting sandflies are known for transmitting leishmaniasis, but sandflies also transmit sandfly fever viruses that may disrupt military operations. Sandfly fever is caused by serotypes of the Phlebovirus genus (primarily the Naples, Sicilian, or Toscana serotypes). The illness is known colloquially as "three-day fever" and "papataci fever." The clinical course of the disease normally spans about 3 days, with patients exhibiting a prodromal phase consisting of fatigue, chills, abdominal pain, and possibly facial flushing and tachycardia. Disease onset is marked by hyperpyrexia, myalgia, and arthralgia. The incubation period is typically 3-5 days, with viremia in humans lasting typically less than 1 week. This manuscript describes sandfly appearance, behavior, and geographic distribution. It then lists comparable diseases for differential diagnosis. Finally, as no vaccine exists for the sandfly virus, it concludes with steps for preparation and prevention to prevent outbreaks from disrupting military operations.

Despite advancements in military medical treatment and evacuation, soldiers in austere environments remain vulnerable to disease and non-battle injury and may face prolonged evacuation before receiving definitive care. In particular, arranging care for a soldier presenting with a conditions that has a wide differential diagnosis, such as acute altered mental status (AMS), can be especially challenging. We highlight the case of an otherwise young, healthy U.S. Soldier serving in Indonesia, who presented with acute AMS concerning for undifferentiated infection. Subsequent workup at the receiving hospital following evacuation revealed Salmonella enterica infection, more commonly known as typhoid. However, even with clinical findings of typhoid encephalitis and initiation of empiric treatment, medical care proved challenging in the resource-limited local facilities, despite multiple escalations of care. Ultimately, the patient was evacuated to a tertiary facility in Singapore, where his condition improved, and 4 days after initial presentation the patient had no definitive findings of infections on lumbar puncture. This case not only highlights the threat of typhoid and other infectious diseases in modern operations but also the challenges of suboptimal medical care in both the prehospital and hospital settings when utilizing host nation facilities.

Tattooing is an ancient art form widely practiced among Special Operations Forces (SOF) personnel. The ink injected into skin tissue during tattooing often contains various compounds, including impurities and contaminants, which can pose health risks. This article provides an overview of recent research to inform SOF medical personnel about the potential health implications of both new and older tattoos.

Background: In emergency casualty and evacuation situations, manual ventilation using self-inflating bags remains a critical skill; however, significant challenges exist in ensuring safety and effectiveness, since inaccurate manual ventilation is associated with life-threatening risks (e.g., gastric insufflation with aspiration, barotrauma, and reduced venous return).

Methods: This study assessed the impact of audiovisual feedback from the bag-valve-mask (BVM) emergency narration guided instrument (BENGI), a handheld manual ventilation guidance device, on improving performance and safety, immediately and 2 weeks after, with no additional manual ventilation training. In a crossover manikin simulation study with 20 participants, BENGI immediately and significantly improved tidal volume and respiratory rate accuracy.

Results: Intraand inter-participant variations were lower with BENGI, with Poincaré plot analysis showing improved performance that remained for at least 2 weeks following BENGI training.

Conclusion: BENGI's audiovisual feedback improves manual immediately and persistently, making it invaluable for training and clinical use in diverse scenarios, from battlespace to civilian emergencies.

Special Forces increasingly operate in austere environments, which are known to have limited medical support and prolonged evacuation times. On the battlefield, pain remains the first complaint of casualties and can impact direct autonomic stability, recovery, and the development of posttraumatic stress disorder. Although medical education has been improving, medical providers still encounter difficulties, such as lack of human and material resources, while trying to achieve pain management. This article summarizes a survey sent to 35 Special Operations medical providers and suggests possible strategies to address challenges to pain management on the battlefield. Potential solutions have been gathered through medical texts, medical/NATO documents, and medical expertise. Nerves blocks have been identified as valuable tools for pain management in the current battlefield environment, where prolonged evacuation and limited freedom of movement are the norm. The survey showed that, although the vast majority of providers had already received lectures on regional anesthesia, 83% were not trained in it, and 54% had never been made aware of multimodal analgesia. This lack of familiarity highlights knowledge and training gaps in nerve block techniques. Diffusion blocks are a very low-risk, useful, and safe pain management technique, which requires less skill sustainment and resources than more complex techniques. The use of epinephrine as adjunct can be useful for decreasing local anesthetic toxicity and increasing long-term pain management. The need for both education on and training in the use of nerve blocks has been identified by the Special Operations health provider community.

Background: The Military Health System is a unique subsector within the nation's Graduate Medical Education (GME), with a different incentive structure for specialty selection for military medical students compared with their civilian counterparts. Changes by the Defense Health Agency (DHA) in 2017 emphasized a shift in military GME to training "operational" medical specialties. This study sought to gain insight into military medical students' reactions to the 2017 DHA transition by examining whether students continued to select "operational" specialties at similar rates as well as whether students remained satisfied with attending medical school.

Methods: We performed a retrospective analysis of Uniformed Services University (USU) post-match students from 2015 to 2020 using anonymized data from the Association of American Medical Colleges (AAMC) Graduation Questionnaire, separated into pre-DHA (2015-2017) and post-DHA (2018-2020) transition groups.

Results: Regarding both intent to practice an operational specialty and satisfaction with choosing medical school, there was no statistically significant difference between the preand post-DHA transition groups.

Conclusions: Whether preor post-DHA transition, USU medical students demonstrated similar preferences for operational specialties as well as similar levels of satisfaction with medical school attendance, suggesting that this transition may not significantly influence medical students' career preferences nor blunt their desire to enter military medicine.

There is no concise guideline on how to manage a full range of emergency psychiatric conditions that are likely to be encountered on the battlefield. This article examines the best practices on how to best assess and treat suicidality, psychosis, agitation, malingering, and combat stress reactions in accordance with multiple clinical practice guidelines. The result is a proposed model for battlefield emergency psychiatric care.